"That time, so strange, when simple honesty looked like courage."
"I sing and drink, giving no thought to death; with arms outspread I fall upon the grass, and if, in this wide world I come to die, then it's certain to be from sheer joy that I live."
The world could use more words from Yevgeny Yevtushenko these days.
It was an honor to have met him, one of few people who owned the description "larger than life" without question.  His death on April 1st, in keeping with a personality both playful and deadly serious, sent me down memory lane with a number of classmates from the 1990's. 

 
Of course an ER holiday story won’t contain sugarplums, tinsel or Bing Crosby.  Nevertheless, I am compelled to share this because it reflects who we are and why we go to work.  More importantly it reflects how professional and wonderful our nurses are. 
                Paramedics brought in an elderly lady who was “found down.”  We know that EMS message doesn’t portend good things.  Her thoughtful landlord had called 911 when she didn’t answer the door.  Cold, decubiti, confused, profoundly dehydrated, and transferred to our bed covered in stool and urine.  She was wearing eyeliner, hair done.  What had happened?
                As we prepped her for CT, her primary nurse asked me if she could clean her up.
                “Not yet, let’s expedite the CT,” I said.
                She had a brain hemorrhage but it would take the radiologist longer to read the neck CT with all the arthritis.  Her nurse expertly started the bair hugger, the treatments for renal failure, while I talked to St. Luke’s. 
                “Can I clean her up?”
                “Not yet, I’m waiting for the c-spine results.  Don’t move her.”
                Her nurse started a second IV and hung more fluids.
                And as the “no acute fracture” reading came through and I headed back to reassess her, there was her nurse.  “Can I clean her up?”
                Who, working on Christmas Eve, asks not once, but three times…eagerly, for the approval to clean up someone covered in stool and urine?  An ER nurse.  A medical professional of the highest training who nevertheless understands the indignity for the elderly lady who took the time to do her hair and make-up before a brain hemorrhage knocked her to the ground.
                It is a privilege to work with such professional and kind people.
                With much appreciation for those who smuggled in the cookies and fudge I scarfed down against the best intentions of JCAHO during this shift, and with the best wishes for health and happiness in the New Year,
 AJ Knauss
               
               
               
               
               
               
               

It's election night.  And that promise I made at work today that I would not check the stats and just walk the dog and go to bed because I have a freaking early ER shift tomorrow, that ship sailed.  And a glass of wine happened.  And wow, facebook is going crazy and I need a break.  So I reflect on the following.
      I had a message on the answering machine when I got home.  Pushed the blinking light and heard "Hi this is so and so from your bank.  I'm calling for Dean, although, mmm, I guess I might be calling for Anne, I don't want to assume.  Umm.  Anyway, just wanted to thank you for your service and wish you a Happy Veterans's day.  Umm.  Thank you."
       Now, I don't live for generic well wishes from my bank.  I'm pretty sure they don't really have my back.  And I've been in the man's world for a looong time.  So has my husband.  And we both laugh at the Dr. and Mrs. mailings that computers generate that have our names oh so wrong.  Most of this stuff is nt worth my time.  I think kids today call it micro-aggressions.  But I think I will call bank representative tomorrow.  I promise I will be nice. 
       I actually want to acknowledge the pause, the moment of oh, I'm not sure which person is the veteran (spoiler alert, we both are) but I guess its probably the man, um, shit, why did I get tasked to make these calls today?  I kind of feel bad for the guy.  Because the bank clearly didn't give him complete information and without that we fall back on the familiar.  
        Whoever is the next president when I wake up, I will move forward.  Tomorrow that will include an informative phone call to that guy.

Peace.

So I was supposed to fly to the DC area this weekend for work stuff.  And that got canceled.  Which led to me waiting for American Airlines to call me back-in-lieu of-waiting on hold  for 2 hours.  During which time the maid service was at the house cleaning.  The team happened to be two dudes.  Which...don't go there...not at all naughty insert bowchickabowwowng music at all. 
And because I was raised with the strict values of the-woman-cleans-the-home made me feel extra guilty, as it sadly always does because I should be evolved enough to be over that, right?
Why do I still feel guilty that I hire people to clean the house?
Any thoughts, please share.  Because psychoanalysis is freaking expensive and I am a cheap bastard.
Maybe its because when I am home and they are here I don't do anything brilliant.  The pressure is intense.  I must use this time for great writing, great insights, not just hiding in the spare room on facebook, damnit.
But then the airline called me back and were all "we will refund this nonrefundable ticket because we are not even going to pretend that tomorrow is a flyable day.  All our fine print is moot.  We give up."
Stay strong midAtlantic people.  Because my work wimped out for the weekend.  So anything you accomplish this weekend is awesome.

          Turning forty is one of those things.  It comes with assorted “shoulds” courtesy of the media, my family, my profession, but mainly the voices in my head.  You know those magazine articles every now and then with “Forty under Forty” or even more intimidating “Thirty under Thirty”?  Pages of amazing people who have achieved greatness before the cut-off age.  A little part of me, a petty, merit badge focused part of me, pouts.  I won’t be in one of those articles.  Another voice laughs at the other articles, the ones I read in the dentist waiting room for lack of other options, about what to wear at thirty, forty, and fifty.  And then, ominously, the advice articles stop.
                I should lean in, embrace change, go gluten free, do a juice cleanse, manage up, rock a beach body, and be a free-range tiger mom.  Granted, I’m registered on facebook as a 116 year old man so I get some really weird spam suggestions from that venue too.  I lost track.
                I remember meeting women in their forties when I was in high school and marveling at how they had it all together.   Surely the age came with a swag bag of knowledge, style and guts.
                Surely I have something pithy to contribute to the world at this age of wisdom?  I am the medical director for a busy emergency department and practice full time emergency medicine.  I am the mother of an early tween.  I am one half of a dual military couple, as my husband and I juggle schedules and talk acronyms to make sure our days work.  People ask me for advice.
                Some days I am a spectacular mess putting on a great front.
                Other days less so.
                I have learned a few things.  Weekend warrior type athletics will hurt you.  Forty year old tendons and joints need constant use, not bursts of activity to make up for a sedentary week.  Sciatica and arthritis and old sounding ailments are real and can at least be kept at bay by regular exercise.
                For me, that exercise is mixed martial arts.  It is no longer running ten or twenty miles a week.  Forty year old cartilage needs lower impact.  Maybe not water aerobics but probably not pounding the pavement.  Facing this reality is the first hint that I am now playing the back nine.
                I have learned that almost everything for sale is useless.  Trust me.  I get the Hammacher Schlemmer catalog for some unknown reason.  The amount of our economy devoted to vanity is mindblowing.  I don’t live in a cave.  I own stuff.  But I really, really don’t want any more stuff.  And I can look to the horizon and see a kid going to college and think about downsizing.  And that feels good.
                Reflecting on current events in the world, places I have been and things I have seen, I have this to say: I know what scary is and scary isn’t any of the things I used to be afraid of.  Things that are still scary?  In no particular order: hemorrhaging neck wounds, melanoma, violent extremism, the ecological health of our oceans.  Not scary?  Most everything else.
Is mortality scary?  I haven’t decided, which is odd given that I deal with it as a physician on a regular basis.  But we tend to view the patients and their diseases as “the other” and most doctors are pretty sure nothing will happen to us. 
My husband and I compare bucket lists.  Our daughter is developing hers.  Much of it involves travel for all of us.  Some of it involves un-bucket for me: things I will not do again under any circumstances.  While it would be great to visit the Galapagos (and it is on the list) it might be even better for mental health to never take that hotel room right by the elevator or buy those shoes that will fit “after they break in”.  Time has always been precious.  I am more aware of it now.  There is a keen sense of not passing this way again. 
Sorry, fruit flavored beer.  We gave it a go.  It’s not me, its you. 
Ahem, toxic people.  Same problem.
At forty, all I know is that the future will be different than I predict.  Right now you can take pictures underwater with an iphone in a waterproof case.  Taking pictures.  Underwater.  With a telephone.  How far we have come.  Research utilizing PET scans has found that adolescents use not just different parts of their brains to solve problems but in fact have slightly structurally different brains.  The next generation has evolved a modified brain, likely to cope with developments that the older generation can’t even fathom.  So while a part of me is consumed by an urge (there go those merit badge impulses again) to contribute something to society, the other part shrugs it off.  The kids have it.  They will be fine.  I am truly over the hill.
I was hiking in the Rockies over ten years ago.  I was alone and ten thousand feet up.  For a lifelong Midwesterner, the changes in vegetation and temperature on a hike like that are dramatic.  There were green mountain lakes far below and snow under my boots.  Maybe it was the thin air talking but I was certain that if a mountain lion ate me at that moment, I wouldn’t mind.  My life was complete.  It was such a crystalline moment that I think of it still. So many blessings have come since then.  If the mountain lion tried it tomorrow, I would fight back. 
You had your chance then, I’m busy now.
 
               
 
 
 

Follow this logic train.  When I come across poison ivy I basically burst into flames.  And apparently it still has roots in the garden bed I thought was clear after the unenvironmentally kind treatments sprayed there last year.  Several itchy days later due to the swath across my neck and face where I wiped my gardening hands, I am on a short course of steroids to knock this out.  Which leads to insomnia.  Which leads to screenplay editing, trying out log lines, shortening log lines.  Poison ivy, you cannot take credit for a writer's productivity.  You still suck.  Let's be clear about that.
Writing and 'roids.  Who knew?